降低再分布低温的诱导技术：一项前瞻性、随机、对照、单盲有效性研究。

Induction techniques that reduce redistribution hypothermia: a prospective, randomized, controlled, single blind effectiveness study.

机构信息

Department of Anesthesiology, Albert Einstein Medical Center, 5501 Old York Road, Philadelphia, PA, USA.

Albert Einstein Healthcare Network, Philadelphia, PA, USA.

出版信息

BMC Anesthesiol. 2019 Nov 6;19(1):203. doi: 10.1186/s12871-019-0866-8.

DOI:10.1186/s12871-019-0866-8

PMID:31694576

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6836364/

Abstract

BACKGROUND

While much effort has been devoted to correcting intraoperative hypothermia, less attention has been directed to preventing redistribution hypothermia. In this study, we compared three different anesthetic induction techniques to standard IV propofol inductions (control) in their effect on reducing redistribution hypothermia.

METHODS

Elective, afebrile patients, age 18 to 55 years, were randomly assigned to one of four groups (n = 50 each). Group "INH/100" was induced with 8% sevoflurane in 100% oxygen, Group "INH/50" with 8% sevoflurane in 50% oxygen and 50% nitrous oxide, Group "PROP" with 2.2 mg/kg propofol, and Group "Phnl/PROP" with 2.2 mg/kg propofol immediately preceded by 160 mcg phenylephrine. Patients were maintained with sevoflurane in 50% nitrous oxide and 50% oxygen in addition to opioid narcotic. Forced air warming was used. Core temperatures were recorded every 15 min after induction for 1 h.

RESULTS

Compared to control group PROP, the mean temperatures in groups INH/100, INH/50, and Phnl/PROP were higher 15, 30, 45 and 60 min after induction (p < 0.001 for all comparisons), averaging between 0.39 °C and 0.54 °C higher. In group PROP, 60% of patients had at least one temperature below 36.0 °C in the first hour whereas only 16% did in each of groups INH/100, INH/50, and Phnl/PROP (p < 0.0001 in each group compared to PROP).

CONCLUSIONS

In this effectiveness trial, inhalation inductions with sevoflurane or with prophylactic phenylephrine bolus prior to propofol induction reduced the magnitude of redistribution hypothermia by an average of 0.4 to 0.5 °C in patients aged 18 to 55 years.

TRIAL REGISTRATION

Retrospectively registered on clinical-trials.gov as NCT02331108 , November 20, 2014.

摘要

背景

尽管人们已经投入大量精力来纠正术中低体温，但对预防重新分布性低体温的关注较少。在这项研究中，我们比较了三种不同的麻醉诱导技术与标准 IV 异丙酚诱导（对照组）在减少重新分布性低体温方面的效果。

方法

选择年龄在 18 至 55 岁之间的择期、无发热的患者，随机分为四组（每组 50 例）。“INH/100”组以 8%七氟醚在 100%氧气中诱导，“INH/50”组以 8%七氟醚在 50%氧气和 50%氧化亚氮中诱导，“PROP”组以 2.2mg/kg 异丙酚诱导，“Phnl/PROP”组以 2.2mg/kg 异丙酚诱导，同时预先给予 160mcg 去氧肾上腺素。患者在 50%氧化亚氮和 50%氧气中维持七氟醚，并使用阿片类麻醉药。使用强制空气加热。诱导后 1 小时内每 15 分钟记录一次核心温度。

结果

与对照组 PROP 相比，INH/100 组、INH/50 组和 Phnl/PROP 组的平均体温在诱导后 15、30、45 和 60 分钟时更高（所有比较均为 p<0.001），平均高 0.39°C 至 0.54°C。在 PROP 组中，60%的患者在第一个小时内至少有一次体温低于 36.0°C，而 INH/100 组、INH/50 组和 Phnl/PROP 组中只有 16%的患者出现这种情况（与 PROP 组相比，每组均为 p<0.0001）。